Autism
What is Autism?
Autism is a highly variable brain development disorder that often makes it hard to communicate with and relate to others. With autism, the different areas of the brain fail to work together. The disorder first appears during infancy or childhood, and generally follows a steady course without remission.
Unlike many other brain disorders such as Parkinson’s, autism does not have a clear unifying mechanism at either the molecular, cellular, or systems level; it is not known whether autism is a few disorders caused by mutations converging on a few common molecular pathways, or is (like intellectual disability) a large set of disorders with diverse mechanisms. Autism appears to result from developmental factors that affect many or all functional brain systems, and to disturb the timing of brain development more than the final product. Neuroanatomical studies and the associations with teratogens strongly suggest that autism's mechanism includes alteration of brain development soon after conception. This anomaly appears to start a cascade of pathological events in the brain that are significantly influenced by environmental factors. Although many major structures of the human brain have been implicated, almost all postmortem studies have been of individuals who also had mental retardation, making it difficult to draw conclusions. Brain weight and volume and head circumference tend to be greater in autistic children. The cellular and molecular bases of pathological early overgrowth are not known, nor is it known whether the overgrown neural systems cause autism's characteristic signs.
Most people with autism will always have some trouble relating to others. But early diagnosis and treatment have helped more and more people with autism to reach their full potential.
What causes autism?
Autism tends to run in families, so experts think it may be something that you inherit. Scientists are trying to find out exactly which genes may be responsible for passing down autism in families.
Other studies are looking at whether autism can be caused by other medical problems or by something in your child’s surroundings.
Some people think that childhood vaccines cause autism, especially the measles-mumps-rubella, or MMR, vaccine. But studies have not shown this to be true. It is important to make sure that your child gets all childhood vaccines. They help keep your child from getting serious diseases that can cause harm or even death.
What are the symptoms?Autism is distinguished not by a single symptom, but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Symptoms almost always start before a child is 3 years old. Usually, parents first notice that their toddler has not started talking yet and is not acting like other children the same age. But it is not unusual for a child to start to talk at the same time as other children the same age, then lose his or her language skills.
Symptoms of autism include:
· Differences in communication. Such as a delay in learning to talk, or not talking at all. A child may seem to be deaf, even though hearing tests are normal. About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.
· Repetitive behaviors. Repeated and overused types of behavior, interests, and play. Examples include repeated body rocking, unusual attachments to objects, and getting very upset when routines change.
· Social impairments. Autistic children show less attention to social stimuli, smile and look at others less often, and respond less to their own name.
Contrary to popular belief, autistic children do not prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friendships, predicts how lonely they feel.
There is no "typical" person with autism. People can have many different kinds of behaviors, from mild to severe.
Autism may also include other problems:
· Many children have below-normal intelligence.
·A 2007 study reported that about two-thirds of children with ASD have a history of sleep problems
· Unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinary rare talents of prodigious.
· Teenagers often become depressed and have a lot of anxiety, especially if they have average or above-average intelligence.
· Some children get a seizure disorder such as epilepsy by their teen years.
The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication. Sometimes the syndrome is divided into low-, medium- and high-functioning (LFA, MFA, and HFA), based on IQ thresholds, or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial.
How is autism diagnosed?
Screening
About half of parents of children with Autism notice their child's unusual behaviors by age 18 months, and about four-fifths notice by age 24 months. As postponing treatment may affect long-term outcome, any of the following signs is reason to have a child evaluated by a specialist without delay:
No babbling by 12 months.
No gesturing (pointing, waving goodbye, etc.) by 12 months.
No single words by 16 months.
No two-word spontaneous phrases (other than instances of echolalia) by 24 months.
Any loss of any language or social skills, at any age.
There are guidelines your doctor will use to see if your child has symptoms of autism. The guidelines put symptoms into three categories:
· Social interactions and relationships. For example, a child may have trouble making eye contact. People with autism may have a hard time understanding someone else’s feelings, such as pain or sadness.
· Verbal and nonverbal communication. For example, a child may never speak. Or he or she may often repeat a certain phrase over and over.
· Limited interests in activities or play. For example, younger children often focus on parts of toys rather than playing with the whole toy. Older children and adults may be fascinated by certain topics, like trading cards or license plates.
Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior.These symptoms do not imply sickness, fragility, or emotional disturbance.
· Autism, the most commonly known,
· Rett syndrome,
· Childhood disintegrative disorder,
· Asperger syndrome, and
· Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), which includes atypical autism
Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder. Unlike autism, Asperger's has no substantial delay in language development.
DSM IV Diagnostic Criteria for Autistic Disorder
- A total of six (or more) items from 1, 2, and 3, with at least two from 1, and one each from 2 and 3:
- qualitative impairment in social interaction, as manifested by at least tow of the following:
- marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
- failure to develop peer relationships appropriate to developmental level
- a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
- lack of social or emotional reciprocity
2. qualitative impairments in communication as manifested by at least one of the following:
- delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
- in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- stereotyped and repetitive use of language or idiosyncratic language
- lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
3. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
- encompassing preoccupations with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
- Apparently inflexible adherence to specific, non functional routines or rituals
- tereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
- Persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interation, (2) language as used in social communication, or (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative
Your child may also have a hearing test and some other tests to make sure that problems are not caused by some other condition.
How is it treated?
The main goals of treatment are to lessen associated deficits and family distress, and to increase quality of life and functional independence. No single treatment is best and treatment is typically tailored to the child's needs.Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors. Available approaches include applied behavior analysis(ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children and is well-established for improving intellectual performance of young children. Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided.
Many medications are used to treat ASD symptoms that interfere with integrating a child into home or school when behavioral treatment fails. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. Aside from antipsychotics,there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. A person with ASD may respond atypically to medications, the medications can have adverse effects and no known medication relieves autism's core symptoms of social and communication impairments.
With early treatment, most children with autism learn to relate better to others. They learn to communicate and to help themselves as they grow older.
Exactly what type of treatment your child needs depends on the symptoms, which are different for each child and may change over time. Because people with autism are so different, something that helps one person may not help another. So it’s important to work with everyone involved in your child’s education and care to find the best way to manage symptoms.
There is no known cure.Children recover occasionally, so that they lose their diagnosis of ASD;this occurs sometimes after intensive treatment and sometimes not. It is not known how often recovery happens
How can your family deal with having a child with autism?
An important part of your child's treatment plan is making sure that other family members get training about autism and how to manage symptoms. Training can reduce family stress and help your child function better. Some families need more help than others.
Take advantage of every kind of help you can find. Talk to your doctor about what help is available where you live. Family, friends, public agencies, and autism organizations are all possible resources.
Remember these tips:
· Plan breaks. Daily demands of caring for a child with autism can take their toll. Planned breaks will help the whole family.
· Get extra help when your child gets older. The teen years can be a very hard time for children with autism.
· Get in touch with other families who have children with autism. You can talk about your problems and share advice with people who will understand.
Raising a child with autism is hard work. But with support and training, your family can learn how to cope.